Pretreatment prognostic factors for overall survival in primary resistant acute myeloid leukemia

• Published in: Biomedicine & pharmacotherapy 2012-12, Vol.66 (8), p.578-582
• Main Authors: Colovic, N, Tomin, D, Vidovic, A, Suvajdzic, N, Jankovic, G, Palibrk, V, Djunic, I, Djurasinovic, V, Virijevic, M
• Format: Article
• Language: English
• Subjects: Acute myeloid leukemia; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor - analysis; Biomarkers, Tumor - biosynthesis; Blood Cell Count; Bone Marrow Cells - metabolism; Bone Marrow Cells - pathology; Comorbidity; Cytarabine - administration & dosage; Cytarabine - therapeutic use; Daunorubicin - administration & dosage; Daunorubicin - therapeutic use; Drug Administration Schedule; Drug Resistance, Neoplasm; Etoposide - administration & dosage; Etoposide - therapeutic use; Female; Hemoglobins - analysis; Humans; Immunophenotyping; Internal Medicine; Kaplan-Meier Estimate; Karyotyping; Kidney Function Tests; Leukemia, Myeloid, Acute - blood; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - genetics; Leukemia, Myeloid, Acute - mortality; Liver Function Tests; Logistic Models; Male; Medical Education; Middle Aged; Poor prognosis; Prognosis; Remission Induction; Resistance; Risk Factors; Treatment Outcome
• ISSN: 0753-3322; 1950-6007
• DOI: 10.1016/j.biopha.2011.11.006

Abstract Aim Primary resistant acute myeloid leukemia has a very poor prognosis. We assessed pretreatment parameters for their significance as prognostic factors in the overall survival (OS) of 53 acute myeloid leukemia (AML) patients who had failed to achieve complete remission (CR) after first-line standard-dose remission-induction therapy. Results During the period January 2005–December 2009, 53 with acute myeloid leukemia received two cycles of the 3 + 7 protocol as a first-line standard-dose remission-induction therapy (ARA-C, days 1–7 and daunorubicin, days 1–3). The HiDAC (5 patients), MiDAC (7 patients), and FLAG-IDA protocols (3 patients) were given as salvage therapy. None of these patients achieved CR. There were 27 (51%) males and 26 (49%) females (median age, 55 years, range 28–76). The median white blood cell count was 53 (range 0.9 –350) × 109 /L, platelets 44 (range 3–856 × 109 /l) and bone marrow blasts 67%. HCT-IC comorbidity scores were 3 in two (3.8%) patients, 2 in 11 (20.8%), 1 in 12 (22.6%) and 0 in 16 (30.2%) patients. Median OS was 3.9 months (range 1 –20 months). The hepatomegaly, white blood cell count, ECOG PS, serum level of lactate dehydrogenase, dysplastic changes, coexpression of CD64, CD15, CD11b, comorbidities and disease cytogenetics influenced survival. Conclusion This single-center study evaluated the significance of pretreatment factors, and found that patient age, comorbidities, ECOG performance status, leukocytosis, hepatomegaly, LDH, and the disease cytogenetics were factors which influenced the outcomes of primary resistant patients with acute myeloid leukemia. An understanding of these factors may help to predict OS in cases where CR has not been achieved and may help when making further treatment decisions.